Tag: FMLA

P: Hi, thanks so much for coming on the show. Can you introduce yourself and tell us where you’re from?

 

Kristy: I’m Kristy Culp-Leonard and I’m from California. 

 

P: Cool. Thanks for coming on the show Kristy. One thing I should bring up before we really get into it is that you are a midwife, which is super cool. So But before we talk about your kids, why don’t you tell us how you came to midwifery?

 

K: Oh, wow. Well, that’s a long journey ago. I’ve been a certified nurse midwife since 2002. I was my in my early years in college, I did public health work in Latin America, and was very much interested in Spanish speaking culture and then found myself to also be interested in public health and working with families and decided to go on to nursing school with the idea was going to be a nurse practitioner and work with women and families, and then learned about becoming a certified nurse midwife and being able to really care for women through their lifespan and work with them. Through labor and birth and empowerment and post birth. So that’s how I ended up being a certified nurse midwife.

 

P: That’s very cool. Where are you in Latin America, what countries.

 

K: I have an in Paraguay twice. Costa Rica. And Mexico twice. 

 

P: I assume you’re fluent in Spanish. I’m totally jealous. Oh my god. That’s very cool. Did you become a nurse midwife before you had kids? 

 

K: I’d graduated from the University of San Francisco with my bachelor’s in nursing. moved to Houston Texas. Wow get work experience knowing that I wanted to be a nurse midwife. So my app the time fiance but now husband, we just packed up and moved there and and I worked is an OB nurse in labor and delivery are about five years before I went to midwifery school at University of Texas in Galveston.

 

P: Okay, so you’re a midwife first. So how do you step into pregnancy? Many of us who you know we’re just civilians, we walk into pregnancy with this very idealized view of what it’s going to look like. But I wonder how people in the know might approach it.

 

K: so we were very plans. husband went to law school, some work experience. I was getting my graduate degree in midwifery getting all of our degrees out of the way. Kind of like a lot of Silicon Valley couples these days. 

 

P: Yeah, 

 

K: and work experience and then decided on having a family also decided to go back and get a master’s degree which kind of threw a wrench in it all. But that’s, that’s okay. I was a professional as an as a certified nurse midwife at the time, and then we encountered some trouble getting pregnant and had to seek out some assistance there. So that kind of threw us for a loop because I had at the time done a lot of internships in birthing centers and home birth and just really had this dream of a beautiful waterbirth with my colleague in her birthing center, and all of a sudden those dreams came to a halt because we had to work on getting pregnant, not the most traditional way at home. So but we were pregnant with our first try through assistance. Twins. 

 

P: Wow. I remember when I was pregnant, and we got that first ultrasound, and they’re like, I see a heartbeat and I was like checking CVC and other one was keep looking around there. So that to me feels like a feels like a lottery win. When were you excited for twins?

 

K: I was not my husband was super stoked. He was like, oh two for the price of one. I immediately as a midwife, and having previously worked as a high risk OB nurse. I was stressed, worried about premature birth. Worried about being laid up at home in bed all the time during pregnancy. I was not excited at all. In fact, it probably wasn’t really embracing it until about halfway through the pregnancy.

 

P: So this is a difference between knowledge and no knowledge, which is you and me because I would have no idea what the risks are. So I like your husband will be like oh my god, this is so great. We only have to do this once. 

 

K: Right? And I was not feeling that and you kind of at the beginning of pregnancy in general. You don’t feel that great or most people don’t feel that great with morning sickness and just feeling really tired. I think with twins, you have a much higher risk of morning sickness. So just knowing that in my mind, I kind of went full force with all of the natural remedies like taking vitamin B and trying all of the other natural remedies like ginger and just making myself eat a snack every two hours regardless of how I felt. So I think that kind of stuff was really important at first I was also extremely worried about the future, looking all the way forward to school days with twins and parenting twins. And is it right to have them in the same class or not? And so I’ve all of a sudden had to like start reading general lay persons literature about parenting twins and trying to not look at it from a clinical perspective.

 

P: yeah, yeah, You’re right that it does obviously bring up 100 different challenges for parenting that you may not have. It just does having twins mean you can’t do the waterbirth 

 

K: correct

 

P: okay, so you also do that? 

 

K: Yeah. Oh, yes. During our pregnancy, we went to a cloth diapering class at my friend’s birthing center. And it was it was the first time my husband had ever been there. But I had been there to seeing as a student nurse midwife, and assisting in birth, I said, Hey, let me show you this place and we walked around and he was like, Oh, my gosh, this is seems so awesome. Why can’t we have the babies here? And I was just like, Oh, you just like crushed my dreams.

 

P: Yeah I’m on a slower learning curve with your husband there. It was. It would have taken me going as well to be like, Oh, this idea. So how was the pregnancy?

 

K: Actually my pregnancy went pretty well. Probably around 12 weeks of pregnancy. I let most of my co workers know. I was pregnant and they were super kind and took me off of night calls. So I didn’t have to do night call in the hospital.

 

P: So it occurs to me that very few professions would be so understanding about pregnancy in terms of what your schedule was like, is there are they just being kind or is there clinical evidence to suggest you need to sleep or you shouldn’t have interrupted sleep or anything like that?

 

K; that’s a Good point. I think that we know being mindful and having less stress is really important for pregnancy. And however, there’s not a lot of great supports in the workplace for that. We experienced this with all kinds of professions I do when I’m caring for patients. And they happen to have the night shift whether they’re working at Home Depot stocking housekeeper for a hotel or a nurse in the hospital. Yeah, and there’s really not much as a professional that I that we can do except for just saying, you know, it’s really important to manage your life when you’re not at work. Make sure you’re getting adequate sleep for me because I’m a nurse midwife. We work in the office so we have daytime work hours as well as nighttime work hours, and you swap back and forth a lot. So I think if there was another person in my practice that had a singleton pregnancy, the group might not have been so supportive. But knowing that this was twins and I think some people knew that it was challenging for us to get pregnant. They were supportive 

 

P: kudos, to practice for doing the right thing.

 

P: so I was impressed by the nurse midwives in Kristy’s practice before I did a lot of research but it turns out that researchers think there is a relationship between sleep and birth outcomes. There’s some studies in both humans and racks that suggest as you might expect, that sleep deprivation is associated with worse outcomes for mother and baby. It’s associated with higher rates of gestational diabetes in the mother, which is probably not super surprising. Since there’s a bunch of research about how sleep deprivation interferes with glucose metabolism in people who aren’t pregnant. But in pregnancy, this problem can be shared with the fetus and affect this development. One study found a higher rate of preterm births. Another found that sleep deprivation of the mothers was related to higher BMI. And higher risk for overweight or obesity in girl babies, but not boys. It’s nice to see a practice treating one of its own in a way that is consistent with good birth outcomes. Now we just need the rest of the workforce to follow suit and think more carefully about how pregnant women are treated since it fell in love who’s affected it’s also the baby which translates into public health.

 

K: I was still working a solid 40 to 50 hours a week. Yeah, it’s the removal of night call was extremely supportive and helpful. Yeah.

 

P: That’s awesome. So, so 12 weeks you tell everyone and you’re doing pretty well. And then for twin pregnancies, does it start imagining and starts to feel harder to carry the pregnancy just kind of physically earlier than it does for a single family? Is that your experience? 

 

K: Yes. When I was 12 weeks pregnant, my tummy was probably more like 18 to 20 weeks sighs maybe still you can hide it and scrubs. 

 

P: Yeah, 

 

K: at work. Well, yeah. And then around 30 weeks, I looked like I was gonna deliver. Yeah, it’s just extra heavy weight and little ones growing in there.

 

P: Are there any recommendations for twin pregnancies like different levels of vitamins or something else you’re supposed to do?

 

K: Yeah, I did do some early reading in the pregnancy and what I was basing it off of was like a twin mom book that I had read about vitamins and protein being really important to try to prevent preeclampsia in pregnancy.

 

P: One thing that’s interesting about talking to Kristy is that she’s in the medical field so likely in touch with the most up to date information. And in the last 20 years since she’s had kids, information, ideas about preeclampsia have changed. So for example, around the time when her kids were born, doctors used to say that preeclampsia resolves with the delivery of the baby in the placenta. And now doctors think that preeclampsia is not a condition cured. By delivery. And long term women who experienced preeclampsia are an increased risk for heart and kidney issues. Researchers used to think that protein intake might be related to the incidence of preeclampsia, as well as calcium, sodium, iron and folate. But now more extensive studies suggest that we can’t link protein or these specific micronutrients to the development of preeclampsia. So medical community has known about preeclampsia for something like 2000 years, but we still don’t know what causes it. Having said that, you can’t really go wrong by pursuing a healthy diet. The only trick there is defining healthy

 

P: are you at higher risk with twins? 

 

K: Yes. 

 

P: Okay. 

 

K: higher for gestational diabetes, preeclampsia. And so I just really managed my nutrition really well. And made sure my body was nurses like those cupcakes. Eating those I was like, I’m not doing it. I because I don’t have a lot of space, right? 

 

P: Yeah, yeah. 

 

K: So it has to be pure value if I was eating it.

 

P: That’s an impressive thing to follow. Because it takes a lot of willpower and you’re already tired with my first pregnancy. I was really careful about eating what I imagined in Olympian would eat. And with my second one, I was nauseous the whole time and only ate hotdogs and I’m a vegetarian. So it’s disgusting and under no circumstance should anyone consume that many hotdogs but I just I couldn’t I couldn’t hold anything else down so I’m impressed that you that you kind of traveled the straight and narrow….that’s a hard thing to do.

 

K: Well, interesting thing is, this was back so they were born in 2004. Yeah, so it was near the end of my pregnancy. I think I remember reading an article about professional article about mere mercury and fish and really the types of fish we should be limiting during pregnancy. Like all of that information started coming out. Yeah. One of the things was albacore tuna. Oh, my main sources of protein during my entire pregnancy was albacore tuna. So I stopped eating the albacore tuna probably about and went to chunk light tuna, probably only about a month before they were born. That was really science.

 

P: Totally, totally it you know, you’re you’re doing your best and you’re you’re better than Mrs. Hot dog. So that’s a we’ll take a week yet. So how far do you get to your in your pregnancy?

 

K: Well, that’s an interesting situation. They were born 39 weeks and four days. Wow. That’s 2004 Oh, so about I think it was about a year or two after that recommendation from maternal fetal medicine was that twins should be delivered by 38 weeks of pregnancy because of risks of the placenta, just aging and maturing a little bit faster and maybe not functioning as well. At the end of pregnancy, also risks of hypertension in the mom.

 

P; So did you make it to that late date intact? Is there any obvious cost to you for going longer?

 

K: But I worked all the way until 39 weeks? Oh, wow. I was living in Texas. We don’t have state disability there. So I had to work. And I actually I probably had preeclampsia in retrospect. And they were most likely some pretty solid signs of it starting around 37 weeks.

 

P: What so what happened that what happened that wasn’t caught by her practice?

 

K: well, I think there was this feeling of oh, she’s gonna be fine. When she lays down her blood pressure goes down. So a couple things we look at when there’s preeclampsia and pregnancy is maternal blood pressure. If it’s elevated, then that signs of at least hypertension, high blood pressure and pregnancy and then if there’s protein in your urine that’s a latter sign of eclampsia as well. So I had intermittently small amounts of protein in my urine, but when I would lay down my blood pressure wasn’t really elevated at all. So 

 

P: are the guidelines for the blood pressure positional 

 

K: not really like your body shouldn’t be shooting high blood pressures, intermittently like that? 

 

P: Yeah. 

 

K: I’m currently speaking about hypertension from my current knowledge and what the guidelines are currently. Yeah, this is back in 2004. 

 

P: Yeah, 

 

K: we weren’t as strict okay about hypertension in pregnancy. So I would go into the office and be checked and then I would take a couple breaths and my blood pressure would be fine. And then I would go home and I feel fine, no headache or anything like that. And then at 39 weeks, in a couple of days, I had an office appointment. And my blood pressure was sustaining of pretty high, pretty high numbers. In that practice. I was sent home to rest with a plan to be induced the next day, when a bed opened up. If I had at that time if I had seen a person in my practice with those blood pressures. He would have said Beeline it to the hospital right now. But I was in a different practice slightly different guidelines at that time. So I said, okay, I’m fine to go home because I’m in my heart. I didn’t want to be induced. But clinically, I knew it was right to be induced.

 

P: Well, that sounds like a tricky thing. And advances in medicine take a really long time. This doesn’t seem all that long, right? It’s like 17 years. Right? So it’s interesting how much we have learned about pregnancy in the since well, I have a 2004 birth also. So since those kids yeah, I feel like a lot has changed. 

 

K: I’m going to rewind a little bit. So just share one of the things about twin pregnancies, 

 

P: yeah. 

 

K: And route of delivery though. So it’s in twin pregnancies. We have to be concerned about the two babies and the position that they are in the womb. So ideally, you have babies in the womb that are both head down. And we checked out at the end of pregnancy and if a person’s desiring a vaginal birth, and we move forward with plans for vaginal birth twins are both head down. 

 

So in my pregnancy at around 28 weeks, first baby twin A is head down but Baby B was Baby B had prior to that then head down or vertex so he continues to be breach breach breach, and I started going bonkers thinking I’m not having a cesarean birth and talked to my OB was in support with my midwife and I said I know you have a lot of experience with a breech extraction. And we need to have an honest discussion about this because I really want to have a breech extraction with Baby B. And he kind of was not giving me like an absolute solid answer on that. Well Kristy, we’re just gonna kind of roll with it and see how it goes. And let’s just seeing it that baby turns. I start getting stressed about this and start at around 

 

P: thats  a stressful answer. 

 

K: right? I think it’s yeah, it probably didn’t help that my husband is an attorney either. So we have a midwife patient and houses an attorney and honestly, so I enlisted some support of local pregnancy natural support people in Houston. First I went to my acupuncturist said we got to do something to help this baby turns her head down and they’re like, no, what we’ve got we we do have tricks for that, but not when there’s a twin pregnancy. You can do some acupuncture to help with relaxation. Oh, I did that. Then there’s a doula massage therapist in Houston at the time, who was known for pregnancy massage and helping open up the lower back and the mostly the lower back of, of the pregnant woman at her hips. In her massage techniques, and frequently breech babies would turn to head down. So I started seeing her like two to three times a week, around probably around 35 weeks of pregnancy. It wasn’t cheap. It was well worth it. Initially, I knew there was an OB physician in Houston. That’s known for his technique at doing vaginal breech births, which now is more of a lost art, especially for the first time mom and I had actually like looked into going to him to transfer care. It was like 37 weeks of pregnancy. 

 

P: Yeah, 

 

K: really late. 

 

P: Yeah. 

 

K: So if I did transfer care to him, though, it was going to be extremely tricky. It was going to definitely be induced labor because of his call schedule and where he worked. It was going to be a lot more medicalized than I was really desiring so I decided to stick with my team. I was super nervous about being in the hospital, even though I work in a hospital and literally went on two tours of the labor and delivery unit with my midwife. I was just like, oh, I have to see where I’m going to be. I have to see the operating room. I know I’m going to give birth in there so I’ve got to got to feel comfortable here. So fast forward to about that 39 week visit where my blood pressure is going up. We do an ultrasound and lo and behold, Baby B is head down as well. 

 

P: Oh, Wow, 

 

K: so I’ve got two babies that are heads down. And at this point, I was like, Okay, this is great. I’m totally on board with being induced. I know I have high blood pressure. This is a bummer but I can do this.

 

P: Is it riskier to be induced? What if you have high blood pressure?

 

K: not necessarily, I mean, it’s risky to stay pregnant, 

 

P: okay. 

 

K: Depends on how high your blood pressure how high the person’s blood pressure is, and if we can control it, so sometimes there’s people depending on where they are in their pregnancy in the way the baby’s laying that do need a cesarean birth as a  result of their high blood pressure, okay? 

 

P: but You’re not that person. So, now I’m imagining your bag is packed and you go in for your induction.

 

K: Well, my bag is packed. And I go home and I from the office and I sleep right? And then we call the next morning. We’re ready. Like when should we go in and they’re like, You know what, we were really busy all night. We don’t have a bed. So, 

 

P: wow. 

 

K: So eventually that evening, have a bed for me. And so we go in to be induced 

 

P: and how did that go? 

 

K: We get there and one of the midwives from the group, probably I would say the people always have personality clicks, right. And so she’s like one of my favorite midwives in the group. She was on call that night. So she comes in and she checks my cervix. And I was thinking I was like, you know, maybe a half a centimeter dilated or one because my physician the day before checks me and she looks at me with all honesty and she said you know, Kristy, I think doctor was really generous. Yesterday, your cervix is rock solid. 

 

P: Oh 

 

K: hard and you are not dilated. So I’m just gonna start this induction

 

P: so you’re starting from ground zero 

 

K: there is what I’m starting from ground zero and we started with Pitocin and my IV from ground zero.

 

P: Well, that doesn’t sound comfortable already.

 

K: Really, but here’s the thing. Things that happens when a woman has preeclampsia and I’ll be honest, I don’t truly understand the physiology of this but a true a person with true preeclampsia many times once their body is into labor, they just go and their bodies like we know we have to cure this by delivering the baby in my case babies and placenta so also as pretty. I feel like I’m fortunate my mom has really good birthing genes. She’s just kind of like that person that accepted labor contractions and just went with it and had a baby in a normal ish amount of time. So I just kept thinking about my mom during the labor and go and thinking like I’ve I’ve got my mom’s genes on my side, I can do this. My husband and I did have a doula with us. It was someone that I had worked with in the community, so I knew her do her techniques. I felt super comfortable with her. 

 

So she was there for our labor. The beginning of the labor, we started with Pitocin it was a little rough. I had a newish nurse caring for me. So this was the hard part. Because remember, I had been a nurse before I was a midwife I have ideas and how a nurse should be 

 

P: Yeah, yeah. 

 

K: And I don’t think we were a good personality fit. That’s okay, but one of the things for me was don’t offer me pain medicine. I’m very much aware of what the options are. I’ll let you know if I want it. And the first couple hours all of a sudden into labor I just had some excruciating pain in like, of my lower quadrants on my abdomen and it would not let up at all.  In retrospect I think it was probably one of the babies like just elbowing me and was just like, This is what I’ve got to do to come out so deal But The team was pretty like worry about my level of pain, because it wasn’t related to contractions. It was like this severe shooting pain and rare but we’re always concerned what if there’s a spontaneous uterine rupture like it’s thin and it ruptures or something we’re more concerned about that of course and someone that’s having a vaginal birth after cesarean but the twins do create an over distended uterus, so we turned off the Pitocin for a while. And the nurse of course offered me pain medicine. 

 

And I was like, we’re not going there. My doula will be in in just a moment. And I think like at that point, I was probably only like, one and a half centimeter dilated or maybe even one. Like I knew this was gonna be a long night and a long next day, and I’m sure everyone in the background was like just shaking their head and rolling their eyes at the midwife laying in the bed in room, whatever. But my Doula Nadia came and when she was there, I just felt like super confident and comfortable. And something just changed. And I said, let’s start that Pitocin backup. Come on, like we’re not going to sit here all day. 

 

P; Yeah, 

 

K: or really. It was at night. And I think we started the Pitocin backup around midnight. And things just truly picked up at that point in they did not have any option for like cordless monitoring or anything like that and the bathroom was across the room from the fetal monitoring.

 

But I felt the best sitting on the toilets. So I had every like side effects like nausea, vomiting, and and I was like, Well, I’m gonna I’m gonna go to bathroom. I need to go to the bathroom. And I just kept getting off the monitor and going to the bathroom. And I begged my midwife please can we just like let me take five minutes shower. Like because I was trying so much just be in the shower because I knew that water is like what we call an agua dural. So water is super helpful for support but I couldn’t be in there. Because they had to monitor the high risk pregnancy. And keep in mind I had high blood pressure too. My midwife had to come in and give me a little lecture on how it was really important to be on the monitor. So we went back to the bedside, and I was on the monitor and then the nurse kept fiddling around with the monitors on my tummy which drove me crazy because the night before I got into so I broke out with a rash called pups, which is an itchy rash all over it was all over my lower abdomen and thighs. 

 

And so I was extremely sensitive to fetal monitors. I was just getting annoyed with them adjusting them the whole time. So my bag of water had broken and my husband was super stoked and excited things are moving along. And Nadia and I just looked at each other and we’re like, we’re not gonna make a big deal out of this out the bag of water breaking and we just kind of just kept laboring because we felt like the more the nurse wasn’t in the room, the better it was for my mental state and progress, which absolutely was true. They should have changed I should have asked for a different nurse or they should have changed us or something.  Bad personality fit but that’s okay. 

 

At Some point my husband goes outside to get ice and water and he’s just so excited and he tells the nurses all we think her bag of water broke about an hour ago.

 

P: Oops.

 

K: Exactly. So Nadia and I when we heard that, that he did that we were just shaking our heads because we knew we were like doing this on the down low or not telling anyone because we knew the babies were fine like listening to their heartbeat. And we knew that they had central monitoring outside of our room and they could see their heartbeat tracings. So it was fine. So the nurse comes in, you know, we get scolded, how come you didn’t tell me? Because everything’s fine. That’s why we didn’t tell you I literally I had to calm her down. I said because everything’s fine. That’s why we didn’t tell you. And then she, she looks through the pads and she’s like, there’s Meconium in the amniotic fluid. I said yes, there is. It’s like meconium but everything is fine. So there’s nothing we’re going to change about this. We’re just going to keep supporting my labor. I mean, I’m having to labor support my nurse, literally so as much as possible that we could get her keep her out of the room. It was great. 

 

At that point I said you know what, I’m I’m done with you pressing around on my tummy. Can we just put scalp clip on baby as head because it’s hard for you to monitor and I can’t I can’t handle you touching me all the time. And so we agreed to that. I was four to five centimeters already. I was probably like, at three in the morning. Literally. We started Pitocin around midnight, and that was probably around three or four in the morning. 

 

P: That seems fast. 

 

K: oh Yes. It was. And I was really like, don’t really want to be in my mind. I was like, I don’t want to be checks because in my mind I was thinking oh my word. I’m only going to be one centimeter and it’s going to be so depressing. I don’t want to know that I’m one centimeter but I’m bracing myself mentally. I can do this if I’m one centimeter right. And then she’s like, you’re like four to five. Okay, that’s pretty impressive. We put the scalp electrode on the baby and then probably about an hour and a half later I’m still standing at the bedside standing getting on my hands and knees just moaning with each contraction and just taking one at a time. No pain medicine at all. And then probably about an hour and a half later. Started like showing signs of transition shaking. Things were just getting really intense. 

 

I think we had to check on one of the babies or something at that point. Or it could have been a time when Titi was telling me I needed to stay on the monitor again because I was sitting on the toilet a little too often. And so she checked me and I was already seven to eight centimeters. 

 

P: Oh Wow. 

 

K: It was really intense. Pretty sure she left the room and went and called the doc because he was probably at home I’m assuming to say hey, you’re not going to believe this or midwife twin patient is almost complete. And so about an hour, hour and a half after being seven centimeters I was fully dilated. 

 

P: Wow. 

 

K: Yeah. 10 centimeters and bearing down spontaneously. 

 

P: Wow. 

 

K: Yeah. Kind of how my mom’s? I think labor went like smooth that way. Like literally like I really only had like six hour labor though. 

 

P: Wow. So is the delivery smooth now that we’ve gotten complete,

 

K: right? So my doctor, he comes in and he’s just like trying to you know, talk to me and I’m just having contractions back to back. And I’m on my hands and knees and I just keep looking at him going.  This is so hard. This is the hardest work I’ve ever done. This is so hard. That was my mantra. I never said like, I can’t do this. How much longer nothing like that. I just kept acknowledging how challenging the situation was my doula and I didn’t really want to start pushing in the operating room. We really were hoping to like do some of the pushing in our delivery room but with twin deliveries, you need to go to the operating room for the just in case 

 

P: Yeah, 

 

K: there was a scenario and my midwife told me, Oh, Kristy, you’re doing great. You’re not going to push that long. Which I will never say that to a patient because that was the longest hour in my life. So we go to the operating room, and unfortunately in the operating room, you’re laying on a table meant for surgery. It was much different than my my ability to be free standing or on my hands and knees and moving around and squatting. And I was just laying there and with my over distended tummy it was plopping over to one side or the other was very challenging to get my pushing efforts together. There’s probably about like 10 or 15 people in the operating room, which I didn’t really feel or notice, because I think I was used to that. 

 

P: Yeah, 

 

K: but my husband was like, Oh my gosh, what’s going on here? So we just working on pushing a lot of like the nurses had to do a lot of coaching. Eventually, they pulled in this nurse who I had actually worked with when I was a labor and delivery nurse before I was a midwife, and I really admired her and thought she was a great nurse. She just got in my face and was really screaming at me like come on, you can do this. You’ve got this that’s exactly how to do it. And that is truly what got me to help birth my baby. Some people really want to have a calm pushing experience. But I needed somebody to be in my face, coached me through this to give me the feedback. 

 

Additionally, I was like, Wait a minute. It was just running around in here and nobody’s helping me hold my tummy. I was lucky enough. They let my Doula go in. And I think that’s really because possibly my persistence and me being a midwife, and they knew that we had this really good teamwork bond going on. 

 

P: Yeah. 

 

K: And they also they they knew this doula really well. And so usually you can only bring one person into the OR with you but husband and doula both gotta go. And Nadia knew her place and she sat there and she just like worked with me and helps me.  She helped hold my tummy in place. And then I was like, Don’t you know, have a mirror in here so I can see what I’m doing. They got that mirror in there and the nurse was super helpful was coaching me then we had baby A.  so Baby A was born and was handed to the pediatric team I barely got to see are our babies were our their genders were surprised. So that was exciting. 

 

P: that is exciting

 

K: it was a little girl. And I totally didn’t believe my husband when he announced it. That was one of the like the the most important thing I had a birth plan. The most important thing to me on it was nobody announced the gender of our children let my husband look and say it’s everything out like if I got an epidural or something like that, I’d be okay with it. That was the most important thing. So he told me and I was like you got to be like, I don’t believe this. I said, Okay. And then I just remember looking up at him and going, Oh, my God, I got to do this again for the next one. So at that point, there’s in a twin delivery there’s a lot of poking and prodding and everything into the vagina and feeling the cervix and breaking the bag of water and think, you know, ultrasound on your tummy to check the position of baby B and that was that was pretty stressful. So we confirmed Baby B was head down. they broke the bag of water which Ideally,

bring the baby’s head down to the cervix and then you just push the baby out. That’s not what happened in my case. 

 

So my cervix moved back to be about eight centimeters dilated 

 

P: No, 

 

K: yes. But I didn’t know that. And baby’s heart rate started having these huge dips, which I was not aware of because part of me trying to be mindful and in the moment of labor and birth was I absolutely didn’t follow. I didn’t look at the fetal monitoring or anything like that. I was not interpreting anything that was going on. I just said, You know what, I’m just going to take care of each contraction at a time, push the babies out. You’re my clinical people. Trust that you’re monitoring the monitors. Right? 

 

P: Yeah, 

 

K: It’s not my job. My job is to go through labor. Not a midwife today. Oh, I didn’t know his heart rate was doing all these changes. Everyone in the room starts to get a little worried. Doc was in there and you could see the look on his face like oh, he’s like, listen, we have to have a true discussion here. Baby B’s having a lot of decelerations on the monitor. This doesn’t look good. I’d really like to deliver baby soon. But we can go through a few more contractions and see how it is a baby will tolerate it. So we go through a few more contractions and at this point, they turn the volume up on the monitor so everyone knows what’s going on. And then I hear it and I can just hear the dunk. Which is a very slow rate, right? Oh, yeah. And I was just like, Oh no, this isn’t good. I practically sat up on the operating table and I was like, I give you permissions. Put a vacuum or forceps on baby B right now. Let’s just do it and he looks at me and says, You know what? I can’t do it. You’re only eight centimeters.

 

P: Are you surprised by that? Is it normal for the cervix to close? Well, there’s another baby in there.

 

K: I mean, it could but it’s not that like usually in all of my experience. Between deliveries. You break the bag of water. The baby mom bears down the cervix stays dilated. 

 

P: Yeah, 

 

K: you have the next baby. There’s usually like a, like a 10 minute difference in their age or something like that. 

 

P: Yeah. 

 

K: No. And so we try a bunch of position changes to alleviate heart rate changes, and that didn’t work. So I decided that I needed a cesarean birth for the Cesarean birth though I remember I don’t have any pain medicine. 

 

P: Oh, yeah. 

 

K: So I just started to mentally prepare myself that I was going to have to have general anesthesia be put to sleep 

 

P: because that’s faster acting than a seat get an epidural. Right?

 

K: Yeah, I started to get like a little teary eyed and freaked out but I was like, I can’t do that. Because if I’m freaking out, going under, I’m going to be freaking out coming out. Need to just calm down. And I remember the anesthesiologist, just saying in his like lovely think it was a British accent. Listen Kristy just roll over to your side and push your back out and let me see if I think I can get a spinal anesthesia in you really fast. And I was probably the most compliant person ever. 

 

I rolled over. I was laying there for probably like two minutes, maybe three, pushing my back out towards him. Watching the fetal monitor and watching that baby’s heart rate go super low. And then he’s like I got it in control over now. Oh, who’s like the most grateful person ever? Because that is not very common. 

 

P: Yeah, 

 

K: it was literally like three minutes. I rolled over. I looked at the team and I said because you have to have a Foley catheter in your bladder before surgery to keep your bladder empty. And I was like, alright, team, let’s put in that catheter and let’s go then I was kind of a midwife telling them what to do. Then they started the Cesarean birth, and I looked up at my husband and that was really scary. I looked at him knowing what I saw on the fetal monitor and I said this might not be good. It might not come out screaming and crying right away. That’s why we have this neonatal team in here. We’re just gonna like, be calm right now, but this might not be good. And that was sTinker came out. screaming and crying. 

 

P: Awesome. Well done. 

 

K: Yeah, I joke now that it was a vaginal birth. One vagina, one abdominal.

 

P: I feel like you’ve coined a useful phrase here.

 

K: Yeah. I’m like super grateful for the anesthesia team for their skills. Getting that spinal anesthesia in me. I’m super grateful because like, literally that was about three minutes. And they’re under some stress. 

 

P: yeah, Yeah, 

 

K: trying to feel through this and also thinking like, I’m not gonna mess this one up. Yeah. You any wasted three minutes. 

 

P: Yep. Yep. 

 

K: So I’m very grateful for that. Then my husband was like, Oh, we have a boy. So we had a we have a girl and a boy. And I was like, that’s great. Make sure he’s tagged and there there was a nursery and I was like, I need to recover. I’m extremely nauseous and vomiting right now. I can’t enjoy these babies. Send them to the nursery. 

 

P: Yeah, that’s probably smart though,. Right? That that is again, like I think evidence of what real knowledge is helpful for? 

 

K: I think, yes. So for me, I needed to take care of myself so that I could start parenting them better. Yeah, and a couple of hours. I really had to get past the nausea and vomiting because that was horrible. And then I was confident about, you know, the security and the nursery. So going into pregnancy, I thought I was going to have this like singleton waterbirth at my friend’s birthing center, and waddle back to a queen sized bed and have that bonding golden hour after birth with a baby on my chest. But I didn’t I got to see them about two hours after birth. And they were on my chest for months and months after that. 

 

P: Yeah, no, honestly. It Sounds like because you know so much you kind of expected from challenges in your pregnancy and that went pretty well. I mean, that went shockingly well, to make it so late.

 

K: Yeah. I just had to like mostly let go a couple times. I called my Doula one time when I was at work, and I was like, I think I’m having contractions. This is so stressful. I put myself on the monitor and she’s like, Kristy, you gotta take your clinical mind out of this. Go with what how your body’s feeling. I want you to lay down right now and be patient and her support in that sense was super helpful. I wasn’t that person that went home. And listened to the baby’s heartbeats with a Doppler all the time. I have my own Doppler. I could do that. 

 

P: yeah, Yeah, 

 

K: I only did ultrasounds during pregnancy when I needed them. I didn’t I never did them for fun at work. Because I was worried not even to check position. 

 

P: yeah. 

 

K; So I’m, I mean, I’m grateful for my ability to be able to do that. Well, and the support of my Doula friend.

 

P: that seems amazing. Since your kids have been born. Have you seen any other twin births like yours?

 

K: I have not. I don’t think so. Something I’ve been present. Of course, there have been people in our practice that have had vaginal and unnecessary and but most of the time, I have not either somebody chooses to have an elective Cesarean birth for twins, or they have successful vaginal birth times two 

 

P: that is totally interesting. 

 

K: Yeah, one of my best friends who is a labor and delivery nurse, I would have wanted her to be with me if she could have been with me, but she was living in a different state at the time. But she hears my story and she’s sometimes a little bit more on the high risk end and I’m on the low risk end of like, how things go and how we approach and and she’s like, wow, that’s a bummer. Wouldn’t you have just rather just had a cesarean birth to begin with and I was like, No, I got to experience labor and birth 

 

P: yeah, Yeah. 

 

K: And even if I had gotten an epidural, I still would have experienced labor in my mind, but I am happy that I truly experienced a full labor and vaginal birth without an epidural.

 

P: My guess is it’s a boon to your patients. That You have this pretty wide experience in one pregnancy, 

 

K: I could have a better idea of how they feel. 

 

P: Yeah, 

 

K: you know, actually on that note, like it’s, it’s definitely helped me coach people and be genuinely honest with them before having a cesarean birth and what their recovery will look like. Because we talked to people about to cesarean birth, and we’re just really, oh, these are the risks, you know, infection and bleeding and da da da, but we don’t really talk to them much about the sensations, yeah, of recovery. Say a little bit about like, what you might feel during the actual birth, but not all of the recovery, but definitely has helped me change the way I speak to people before Cesarean birth, how their recovery is going to be and also just being supportive with them, even a year after their Cesarean birth if I just meet them for the first time talking to them about the sensations they have, because there’s a lot of things that go on with when your nerves start waking up and the sensations like on your skin level. The tingling and the itching and pulling in the corners of your scar and how weird it is. 

 

P: Yeah, 

 

K: and that’s ignored. 

 

P: Yeah, I mean, that falls into the giant, bottomless postpartum bucket in which wrecks many things are shoved right without examination. How was your postpartum with twins?

 

P: There wasn’t much sleep. I forced myself to take a nap every single day. The whole time. I was on maternity leave, which was only 11 weeks so 

 

P: oh, Wow, good lord.

 

Let’s talk real briefly about maternity leave while we’re on the topic. The US currently ranks 36 Rock Bottom among OECD countries for the carrot provides new parents for maternity leave. Probably everyone listening heard that the attempt to pass a paid leave bill is precarious right now in Congress. current federal law requires 12 weeks of unpaid leave for companies with at least 50 employees. Basically, this leads to about 12% of Americans getting paid leave for 12 weeks. States have passed their own paid leave bills in 2018 and 2019. And these states are basically on the east or west coasts, and they vary in their generosity.

 

K: I was in Texas and I didn’t have a lot of benefits and I guess it was just all I got was my FMLA. That’s it.

 

P: here FMLA is money from the Family Medical Leave Act.

 

K: So it was 11 weeks and the whole time I was on maternity leave for 11 weeks. I made sure I took a nap every single day I was scared to death of getting postpartum depression because I had the blues that was definitely apparent and I probably had some depression but just kind of worked my way through it, keeping my chin up and acknowledging it and taking naps and then once I went back to work, I only went back to work part time which I’m super grateful for my employer, allowing me to change my status. I only worked in the office, so I stopped doing call in the hospital, but every single day I was off. I still took a nap. So we were woken up frequently for a very long time. In fact, our children didn’t really ever sleep through the night until probably about three or four years old. And I nursed 100% A little over a year. 

 

P: Good lord. Wow.  that’s a lot of work…

 

K: I had helped a lot of people with breastfeeding and nursing and the minute they came out of the nursery, I was like alright, we got to nurse these little babies and did send them to the nursery. Again to try to get like a three, three or four hour solid nap in because I was like this was like maybe day two postbirth is one of my midwives from the practice came in to round on me and I got an earful in a lecture from her about how silly it was to send those babies to the nursery. They needed to be with me mammals are never left by their left by their mom, almost pulling their baby cubs every two hours to offer them milk to keep them alive. They need it for survival. I loved Theodora she was also one of my other favorite midwives in the group for background was breastfeeding support and also doula support. The babies had already been latching and stuffing perfectly so I was feeling like pretty overly confident. That’s why I sent him to the nursery but she she must yourself into that nursery brought those two babies back and was like, alright, what is it then you need to nurse them for survival. And honestly with that little pep talk and lecture. I didn’t have any issues with milk supply. I mean, I had to work hard when I got back to work and I was pumping and all of that would pump in my car on the way to work and do crazy things like that, but I never had to purchase formula.

 

P: and Now there have one foot out the door for college right?

 

K: Mm hmm. 

 

P: Amazing. 

 

K: Yep. 

 

P: Thank you so much for sharing your story.

 

K: Thank you

 

P: Thanks so much to Kristy for sharing her story and her insights about pregnancy in general and twin pregnancy, given her professional life as a midwife.  And thank you for listening. We’ll be back soon with another inspiring story.